Hmmm, thinking out loud, is this kind of disparate treatment based on age constitutional? age discrimination? Am I the only one who finds this level of detail into what plan may qualify to be intrusive (to put it mildly), not just into my life but into private contractual relationships? ETA: I realize it's not something that's in the constitution and that case law will mostly pertain to employement. But it seems a rather arbitrary distinction. Hmm....

I only got through about half of this thread so far and I need to go to bed. So, I don't know if this has been mentioned. 1. To decrease health care costs, there must be transparent price information (from health care providers) and customers must have skin in the game. One plan that really intrigued me is for the state government employees in Indiana (it can be googled - there have been recent news articles - maybe WSJ). It is high deductible/low premium catastrophic coverage, with health savings accounts to pay for doc visits, etc. etc. With that sort of system, the premiums are cheaper, and those who cannot afford to fund their own HSAs can be given vouchers or something (forgive me, I can't recall the details) (likewise, I'd like to see Medicare turn entirely into Medicare Advantage - vouchers used to purchase coverage, I think - which unfortunately is being ended under this law). I think in the Indiana example, the HSAs were funded by the employer (the state) and the people got to keep any cash that remained at the end of the year or something. People had responsibility and choice. 2. The disparate tax treatment of employer-sponsored health insurance must end. Currently, individual insurance is purchased with after-tax dollars while employer-sponsored insurance is tax-free. The way to do this is to tax the employer sponsored insurance as income, with a tax credit for all those who have insurance, whichever kind it may be. The goal is a more robust individual market. 3. Allow more competition in the insurance market, i.e., across state lines, like auto insurers. In some state "markets" (if you can call them that :glare:) the insurance regulations are so onerous that they are barriers to entry. These are the regulations that require the policy to cover x, y and z, even if you don't want to buy coverage for that. Unfortunately the new law is the antithesis of this, in that there will be no choice in what risks you want to cover. A public option in the insurance market that is open to anyone, likewise, is the antithesis of competition, for reasons I'm too tired to list at the moment. The problem with universal coverage is that it is by its nature inefficient from an economic perspective. gotta go to bed...:001_huh:

This part I understand, that the cost of treating the uninsured in the ER is an "invisible tax". But what I'm not sure I understand is which part of the new insurance scheme under this new law turns the cost of covering the currently uninsured into a "visible tax". What I am saying is that there are plenty of "invisible taxes", if you will, under this new scheme, both directly (a variety of taxes as well as increased premiums) and indirectly (additional costs to goods and services). Insurance is (or was) risk-covering - that's not exactly the same thing as paying someone else's way. Even though the insurance company uses some of my premium, for example, to finance someone else's care, that's not me paying for it. I have a discrete contract with the insurer: if x happens, they will pay y. If x doesn't happen, they keep my premium. They determine what the odds of x happening are, and price the premium accordingly. The odds hopefully work out in the insurer's favor. But I'm an individual - I care about what works for me, not what works for the insurer [NOTE: I mean that from the perspective of microeconomics, indifference curves, etc. I could go on and on about econ regarding health care but I'll leave it for another post]. In other words, I'm not assuming the risk of the insurer's other customers, *so long as those other risks don't ultimately bankrupt the insurer*. That is the reason for the heavy financial regulation of insurers, to ensure they can perform their end of their contracts. [ETA, even though I am looking at this from an economic perspective, as I think is necessary, I really don't think we disagree about this). Unfortunately I do not think there is any hope of the mechanisms in the bill causing premiums to decrease. For one, I'm pretty sure the CBO has said as much (actually I think they said something like the premiums won't increase quite as fast as without the bill, but they won't decrease). The main reason is that premiums are largely based on health care costs generally, which will continue to increase (basic supply/demand), nothing in this bill addresses that. Indeed, I'm quite afraid health care costs will skyrocket as a result of (1) the additional health care customers and (2) any reaction to incentives to get more care (high premium/low deductible plans). On top of that, with the lack of choice - there will be, basically, a one-size-fits-all approach, the low deductible/high premium "qualified" plan - so people with other formulations of insurance are going to see premiums higher than they have now. This really leaves the realm of traditional risk-covering insurance, since it involves covering an event that is certain to happen (well visits - pre-paid care). It's been a long day, I hope you can understand what I am trying to say, even though you may disagree with it. I do agree with you that there is a lot more awareness of the cost of covering the uninsured due to this new law. I just don't think it will be obvious how much the additional cost is. Everything will cost "more". IMO, it's hard to imagine a worse scheme from an economic perspective - the incentives are backwards (here I go drifting into econ again, problematic because it's been twenty years since I studied it).

I'll take a stab at this, just thinking out loud, if I understand your question correctly. No, I do not think this makes the "tax" any more visible. In this case, our premium, that we pay for our family, is going to help pay for someone else's insurance, someone whose true premium would be higher than they can afford. It is not as though there is x amount of dollars added to our usual premium, like, say, a sales tax or exise tax or even a line item on an invoice. It simply costs "more". The same way that hospital rates cost "more" so that the hospital can afford to cover the uninsured in the ER. So no, I don't think it's more visible at all. In my opinion, the costs (both for insurance and for health care) will rise much more than they would have otherwise, as a matter of economics. IMO, it would have been wiser to try to reduce health care costs first, which by its nature increases access. But that's a very complicated matter, anoyher subject that I don't have time to address at the moment (as if insurance isn't complicated all by itself). ETA: thinking about it some more, I wonder if I misunderstand which "visible tax" you are referring to: the premiums, the penalty for failure to purchase a qualified plan, the increased income tax, the increased capital gains tax, etc. etc. By the way, already today a restaurant chain announced it would be increasing prices in order to cover its new health insurance costs. It would seem that increased prices for things in the market place are a most invisible "tax".

That's what I was afraid of - mandatory pre-paid preventive care.

Here's what I honestly don't understand. Why is the government seeking to get rid of HSAs and high deductible plans? Does anyone know the answer to this? If making insurance more affordable was one of the goals, this doesn't make a whole lot of sense to me.

Thanks for pointing this out - I didn't know there was a teen version. I've been freaking out a little; dd is only 9 but time will fly and we'll have to talk...

I think part of the problem here is that this isn't about being forced to pay into a government system - that's a different question entirely, from a constitutional perspective. It's about being forced by the federal government, as a requirement for living, to enter into a very specific contract with a private entity.

I agree with you, that it's splitting hairs, but sometimes that's what happens in the law. It matters because what may be constitutional (e.g. increase in federal income tax) may be less politically palatable than a possibly unconstitutional penalty for failure to enter into a rather specific contract. I vaguely recall that the Senate didn't like the House bill because it included income tax increases. I have been wanting to find high deductible/low premium insurance on the individual market and pay out of pocket for doc visits, and I've been waiting to see what would happen with the law. I don't believe that type of policy will be allowed, er, qualify, under the new scheme (talk about a lack of choice!). So for now we'll stick with our very expensive group insurance (>$30k).

While I don't know the particulars, I believe that, as far as the federal government is concerned, not all taxes are the same, i.e., not all are constitutional. IMO, it would make more sense from a constitutional perspective to increase the federal income tax and then offer a credit upon proof of insurance (this by its nature would include taxing employer benefits and then crediting it back). In contrast, this penalty, from what I read, can't be a "tax" under the constitution because of the way it is set up. If I find out more later, I'll come back to this to see if I can explain... I don't mean to cause trouble, but I just wanted to point out that, no, not all taxes are equal.

I haven't seen the movie in question, but wouldn't a person with no assets or income qualify for Medicaid? The more I think about it, the more the issue ought to be fixing Medicaid, so that it can cover more people (not that I'd necessarily be in agreement, but isn't the whole point of Medicaid to provide insurance to "poor" people?). Except that Medicaid is already a huge financial problem for the states.... I'm just thinking out loud here....

And then what do you do when your child can out-argue you :glare:. My dd has a sort of LD with language processing - she has trouble with inferences, etc. - but arguing literally she's right every time. Drives me nuts! (guess that should be expected from the child of two lawyers? but there are six of them - can they amend our family constitution to over-rule us :lol:?) Seriously though, I am here because I need the mental stimulation for my sanity. Would that I could take the day off from being mom to analyze the question at hand, but the baby is waking up... ETA: Cammie, I wish I could find what I was reading last night (lots of colorful language, sounded like a drunken bar review discussion), but if you were interested enough to look them up, two of the cases being discussed were Wickard (farmer/wheat case) and a more recent case that I think was called Raich (sp?) in which Alito wrote a concurrence. I'm going to try to find this discussion later because one particuar person's argument made a whole lot of sense to me. Some of them appeared to know what they were talking about (unlike myself :lol:).

In addition to the Commerce clause argument, the issue over religious exemptions was just brought up on the other thread on the bill. I haven't looked closely at it, but I vaguely recall that there were discussions about the constitutionality of those provisions when the bill was passed by the Senate a few months ago. There are some newspaper editorials on the constitutionality issues out there, at least a few, by law professors. I expect there to be more. They can be googled. I will be surprised if this never reaches the Supreme Court, because there is no case law precisely on point under the Commerce clause, at least according to the discussions I was reading last night. I was so bored in Constitutional Law in law school - I obviously learned none of it (the professor, a brilliant man, happened to be very dull). Now more than fifteen years later, I find it fascinating. It's going to be interesting watching this play out. I wish I had time to actually read the case law. Instead at this moment I'm referee-ing an argument about the sharing of Cheezits....(why are they even in my house)

I believe Massachusetts has such a mandate. However, my understanding is that the system there is broke - deeply in debt - and that the numbers of uninsured were not decreased by as much as hoped. Both premiums and health care costs there have skyrocketed. Massachusetts is not exactly a shining example of how well such a system works. But that's just from what I've read - perhaps someone here in Mass. can give us their opinion on how well that is working. I have no idea whether the Mass. mandate was ever challenged on any constitutional grounds - I'd be interested to know. This is an excellent point. In the discussion I was reading last night, some felt that the S. Ct.'s decision in that case was incorrect. Nonetheless, it could be an avenue for Congress in a future law - but that's not in the Senate bill at issue here. Moreover, as mentioned above, the matter is so controversial that several states are suing over this, and I think it's a decent bet that at least some states would decline federal funding in order to avoid enacting a mandate.

:iagree: I was reading a discussion (to put it politely) between anonymous lawyers on a random web site last night - comments to an article - and it was pretty heated. But the gist was that the federal government only has the powers enumerated in the Constitution (unlike, say, the State of Massachusetts). I thought there was a pretty good argument that the Commerce clause, as much as its meaning has been broadened over the years, does not give the federal government the power to regulate an inactivity, i.e. the failure to buy health insurance. That is what some lawyers were saying distinguishes this from the Wickard case. I found that pretty convincing, but perhaps I'm biased. I fully admit to sleeping through my Con Law class. To create an example that was mentioned, of forcing persons to purchase something from a private company, it is laughable to suggest that under the Commerce clause Congress could force everyone to, say, purchase a financial product from Wall Street firms in order to keep them afloat. But that's exactly what the insurance mandate is - forcing healthy people to purchase a financial product so that the insurance companies can afford to cover the sick, i.e. people with pre-existing conditions. It was late and unfortunately I don't remember the reasons they said that the General Welfare clause would not apply, except that it would provide a basis for enacting universal health care. I do think it's a pretty good guess that some hope the private insurance companies go out of business such that universal care is the only thing left to do. In a simple way, with the penalties lower than the cost of insurance and no pre-existing conditions to stop a person, under this law there is little incentive to buy insurance until the person needs it (gets sick/injured). If that happens on a large scale (as one might expect with a number of the currently uninsured - the young and healthy) it is not a financially workable business model. If the mandate was determined to be unconstitutional, I wonder whether the rest of the law could stand, since as a practical matter it's pretty clear that the insurance companies may not stay afloat with the ban on pre-existing conditions. Anyway that's my two cents on the constitutional issues.

I'm not sure if I'm allowed to quote this much, but I noticed this on a news website a few minutes ago. It might help this discussion. (ETA, in my mind this only adds to the consitutionality issues re: the mandate) (ETA again, if this is true, it doesn't make a whole lot of sense. The same news article reported that the legislation did not cover the expense of the IRS, which perhaps - my guess - was because they didn't want the additional cost in the bill)

Another thing to keep in mind here is that, at least as far as I understand, the mandatory insurance isn't just any insurance, but what must be included will be specific. From all that has been said, it is likely that higher-deductible/lower-premium insurance will not qualify, the government's goal being more of a pre-paid preventive care type of policy. The legislation puts the cart before the horse from an economic perspective. The problem I see with the design of this legislation is that it will increase health care costs rather than decrease them. Health insurance and health care are two different, though related, markets. Health insurance costs will keep increasing along with health care costs. Greater demand for health care + unchanged supply = increased prices. However, if the legislation instead focused on decreasing health care costs, lower costs would translate into greater access to care, both for those paying cash and those paying via insurance premiums. How to lower health care costs is another subject...